title: The periaqueductal grey area and control of blood pressure in neurodegeneration.
abstract: The periaqueductal/periventricular grey area (PAG/PVG) is a midbrain nucleus with an important role in pain signalling and autonomic control. We present the case of an initially hypertensive man who developed a presumed neurodegenerative disorder over a decade, characterised by progressive right-sided chronic pain, extra-pyramidal symptoms and autonomic dysfunction including postural hypotension, sleep apnoea, and bladder instability. He underwent a variety of treatments for his symptoms, including deep brain stimulation (DBS) of the PAG/PVG. 24-h blood pressure monitoring was carried out 1 and 5 years after implantation. Although the DBS initially produced a significant reduction in blood pressure, the effect was significantly reversed when the same tests were repeated 5 years after surgery. This may imply a functional involvement of the PAG/PVG in the neurodegenerative process.
authors.affiliation: Nuffield Department of Surgical Science, University of Oxford, Level 3, West Wing, Oxford, OX3 9DU, UK. hollysitsapesan@gmail.com
authors.forename: Holly
authors.initials: H
authors.lastname: Sitsapesan
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Green
authors.forename: Tipu Z
authors.initials: TZ
authors.lastname: Aziz
authors.forename: Erlick A C
authors.initials: EA
authors.lastname: Pereira
mesh_terms: D000978:Antiparkinson Agents / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D046690:Deep Brain Stimulation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008875:Middle Aged; D019578:Multiple System Atrophy / Q000150:complications; D019636:Neurodegenerative Diseases / Q000503:physiopathology*; D019635:Neurosurgical Procedures; D010487:Periaqueductal Gray / Q000503:physiopathology*; D016896:Treatment Outcome; D014202:Tremor / Q000209:etiology
chemical_list: D000978:Antiparkinson Agents